Feedback/Outcome Measures

Monitoring a patient’s progress in treatment gives counselors the ability to adjust the course of treatment if necessary. Receiving feedback on a patient will let them know if treatment has been successful or if they need to provide some form of intervention to re-engage the patient. The ability to monitor a patient’s progress would present clinics with an opportunity to reduce drop outs.

No literature discussing patient feedback in the substance abuse field was found. A meta-analysis of patient tracking in the mental health field found evaluated three studies that provided feedback to counselors through the use of progress graphs and warnings for clients who were failing to demonstrate expected treatment responses. Lambert et al (2003) tried to determine if formal feedback to therapists on client progress improves psychotherapy outcomes. The authors felt that the feedback should allow therapists to improve the results of patients predicted to have poor outcomes.

In all three of the studies, patients filled out an outcome questionnaire during treatment. This questionnaire was used to determine the progress of the client and provide feedback to the therapist. The results show that feedback had a positive effect on retention. Of the patients predicted to have difficulty, 13% in the feedback group deteriorated compared with 21% in the control group. The ability of the therapist to adjust the delivery of treatment had a positive effect on retention.

Within the substance abuse treatment community the idea of Outcome Monitoring Systems (OMS) as centralized data collection sites has gained popularity. The purpose of an OMS is to provide reliable data on client characteristics, services provided and outcomes. Counselors would be able to adapt services based on the data collected. At the moment through government sponsored programs like TOPPS II there is a push to create large state-wide or national monitoring systems (Center for Substance Abuse Treatement TIP 14, 1995). These large systems provide a systematic collection of client, treatment and outcome data from diverse alcohol and drug abuse intervention programs (Brown et al, 2003).

However, the large OMS also present some limitations. The data collected may not have the same effect on the local level. A local OMS can provide additional data that is more in line with the needs of the treatment facility, matching treatment ideology and program development. Brown et al (2003) also reported on areas of future research for OMS. Clinical information must be increasingly computerized to allow for data mining which would be able to create patient progress reports. Also, instruments used to determine patient progress would have to be short enough to be administered repeatedly over the treatment process. This would allow counselors to make real time adjustments to treatment which would hopefully decrease attrition.

No empirical evidence was found which examined the effectiveness of Outcome Monitoring Systems, large or small. Most of the literature available presents general guidelines to get an OMS up and running. Further research is needed to determine the effects of OMS on the retention rates of local treatment facilities.

All of the topics discussed have the potential to reduce no-shows and increase retention in treatment. Treatment facilities and counselors have to be willing to adapt to changing technologies to attempt to maximize the benefits of treatment. Further research is needed in newer technologies to determine their true effectiveness in enhancing treatment outcomes.